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Flashcards in Approach to the Undifferentiated Patient Deck (37):
1

Most common triage coding system

Emergency Severity Index (ESI)

Red-Critical
Orange- Emergent
Yellow- Urgent
Green- Minor
Blue- Very minor

2

Does the patient appear to be unstable or in any distress? Determine this with a basic assessment of

the ‘ABCs’ (airway, breathing, circulation).

3

For unresponsive adults w/ cardiovascular emergency, approach the patient using

“CAB” (circulation, airway, breathing

4

If patient is “sick”, the following events should always occur in parallel

Vital signs asap
vascular access
cardiac monitor
O2 prn

think “IV-O2-Monitor”.

5

Spectrum bias is

test characteristic wherein the test becomes increasingly reliable as the disease progresses

6

Well’s Criteria is for

pulmonary embolism

7

Well’s Criteria

-s/s of DVT
-PE is #1 diagnosis
-HR > 100 bmp
-Immobilization 3+ days
-Surgery in last 4 weeks
-Hx of PE of DVT
-Hemoptysis
-Malignancy within 6 months -palliative care

8

Indications for emergency airway management may include

-hypoxia
-hypercarbia
-AMS
-failure to tolerate oral secretions
-anticipation of a worsening clinical condition.

9

Pain-related complaints are the most common reason for emergency department visits, with _____ & ____ being the two most frequent cc

abdominal pain and chest pain

10

“premature closure

potential pitfall of honing in on a particular diagnosis before all of the information is available

11

At a minimum, all AMS patients deserve:

ABCDE
Cardiac monitoring
pulse oximetry
glucose testing
IV access
Eval for trauma
Consider naloxone

12

AMS = AEIOU TIPS

Alcohol
Electrolytes
Insulin
Opiates/ Oxygen
Uremia
Trauma/ Temp
Infection
Poison/ Psych
Shock/ Stroke

13

Three common broad classifications of AMS include

delirium- emergency
dementia
psychosis.

14

Arousal is mediated primarily by ________

brainstem nuclei- reticular activating system

15

Many medical conditions manifest as AMS when decompensated. Look for a history of:

Meds
DKA/ HHNK
HTN
endocrine disease
renal failure
cancer
dementia
CVD
seizure
psychiatric issues

16

Glasgow Coma Scale compantants

Eyes, Verbal, Motor

17

Glasgow Coma Scale
Eyes

4 – Spont
3 – Loud voice
2 – To Pain
1- None

18

Glasgow Coma Scale
Verbal

5 – Oriented
4 – Confused
3 – Inapprop words
2 – Incomprehensible
sounds
1 – No Sounds

19

Glasgow Coma Scale
Motor

6 – Obeys
5 – Localizes to pain
4 – Withdraws to pain
3 – Abnormal flexion
posturing
2 – Abnormal extension
posturing
1 – None

20

Glasgow Coma Scale and airway

less that eight, intubate!

21

Metabolic or Endocrine AMS labs

Rapid glucose
Serum electrolytes
ABG or VBG
BUN/Creatinine
Thyroid function
Ammonia
Serum cortisol level
Toxic or medication causes

22

Levels of medications AMS labs

-Drug screen- Benzo, opioids, barbiturates
-Alcohol level
-Serum osmolality (toxic alcohols)

23

Hemodynamic instability causes of AMS labs

ECG
Cardiac enzymes
Echo
Carotid/vertebral artery ultrasound

24

AMS diagnosis is never assured until ?

abnormalities recognized and remedied
patient has returned to their normal mental status.

25

AMS rx
________ for agitated withdrawal states

Supportive care and sedation

26

AMS rx
Intravenous fluids for __________

-dehydration
-hypovolemia
-hypotension
-hyperosmolar states (HHNS or hypernatremia)

27

AMS rx
Empiric antibiotics for _____

suspected meningitis
urosepsis
pneumonia, etc.

28

AMS rx
_________ for temperature extremes

Rewarming or aggressive cooling

29

AMS rx
__________ for specific toxins

Fomepazole
pyridoxine
digoxin-fab fragments other antidotes

30

AMS rx
_______ for opioid toxicity

Naloxone

31

AMS rx
____________ for hypertensive encephalopathy

Controlled reduction of BP with
-nitroprusside
-labetolol
-fenoldepam

32

AMS rx
_________ for hypoglycemia

Dextrose

33

AMS rx
_______ for profound hyponatremia with seizures or AMS

Hypertonic saline

34

AMS rx
_______ for metastatic CNS lesions with vasogenic edema

Glucocorticoids

35

AMS rx
_______ for suspected Wernicke’s encephalopathy

thiamine

36

AMS pts who can discharge home

sz
hypoglycemia from DM
Narcotic OD

37

AMS pt asking to leave can if?

patient can demonstrate they understand both the risk of leaving against advice vs benefit of staying